A Human Factors Approach to Support Older Chronically Ill Patients' Home Care

描述（由申请人提供）：拟议的研究旨在为老年慢性心力衰竭（CHF）患者及其非正式护理人员提供信息支持。许多老年患者在家庭护理（自我护理）计划方面的信息需求未得到满足，表现为知识缺乏和高达90%的患者不遵守重要的护理活动，如服药、营养和钠限制、体力活动以及监测和应对症状。不依从的健康后果是巨大的且代价高昂。我们假设，健康信息技术（HIT），当使用人因工程（HFE）的原则和方法进行设计和评估时，对于老年患者和必须管理成功的家庭护理，健康和疾病管理所需的复杂信息的非专业护理人员来说是有用和可用的。 本提案描述了主要研究者（PI）将如何过渡到研究独立性和老龄化研究的职业生涯，建立在他在HFE和HIT方面的专业知识基础上，并在以下方面发展额外的专业知识：a）老年慢性病患者的健康相关特征，以及B）针对这些患者及其护理人员的以用户为中心的HIT设计过程。该提案描述了一个为期3年的研究项目，开发和测试一个交互式飞行计划HIT系统使用HFE的方法。飞行计划最初将由老年CHF患者开发和测试，以支持广泛的疾病特异性和一般自我护理活动。 研究目标1是人为因素分析-熟悉老年CHF领域，访谈，调查和家庭观察的组合。人为因素分析将对未来飞行计划用户、他们的任务、使用背景和需求有一个现实的了解。这种理解对于飞行计划的循证设计至关重要。 研究目标2是飞行计划原型的设计和可用性测试。原型将基于Aim 1的发现和设计团队对以患者为中心、患者控制、交互式飞行的愿景 计划系统。PI的职业发展活动将确保飞行计划符合HFE设计原则，并具有临床有效性。在可用性测试期间，老年CHF患者及其非专业护理人员将在受控实验室和原位条件下使用飞行计划原型。客观和主观可用性测试数据的分析将验证飞行计划的可用性和初步有用性，并指导进一步的改进。 研究目标3是飞行计划的有效性和用户接受度的试点测试。初步试验将是一项前后随机对照试验，包括基线和干预后3个月的健康状况、CHF知识和CHF自我护理行为指标。飞行计划是假设，以改善这些措施相对于常规护理。Flight Plan预计比其他面向患者的HIT系统具有更高的HIT接受度。未来的工作将包括一个更大的随机对照试验，以评估飞行计划对老年CHF患者健康结局的影响，以及将飞行计划扩展到其他老年慢性病领域。

DESCRIPTION (provided by applicant): The proposed research addresses the need to provide information support to older chronic heart failure (CHF) patients and their informal caregivers. Many older patients have unmet information needs related to their home care (self-care) plans, illustrated by knowledge deficits and up to 90% nonadherence to important care activities such as medication-taking, nutrition and sodium restriction, physical activity, and monitoring and responding to symptoms. The health consequences of nonadherence are tremendous and costly. We hypothesize that health information technology (HIT), when designed and evaluated using Human Factors Engineering (HFE) principles and methods, can be useful and usable for older patients and lay caregivers who must manage the complex information needed for successful home care, health, & disease management. This proposal describes how the Principal Investigator (PI) will transition to research independence and a career in aging research, building on his expertise in HFE and HIT and developing additional expertise in the: a) health relevant characteristics of older, chronically ill patients, and b) proess of user-centered HIT design for these patients and their caregivers. The proposal describes a 3-year research project developing and testing an interactive Flight Plan HIT system using the HFE approach. Flight Plan will initially be developed for and tested by older CHF patients to support a broad array of disease-specific and general self-care activities. Research Aim 1 is the Human Factors Analysis - a combination of familiarization with the geriatric CHF domain, interviews, surveys, and in-home observations. The Human Factors Analysis will yield a realistic understanding of future Flight Plan users, their tasks, contexts of use, and needs. This understanding will be critical for evidence based design of Flight Plan. Research Aim 2 is the Design and Usability Testing of a Flight Plan prototype. The prototype will be based on Aim 1 findings and the design team's vision of a patient-centered, patient-controlled, interactive Flight Plan system. The PI's career development activities will ensure that Flight Plan conforms to HFE design principles and is clinically valid. During usability testing, older CHF patients and their lay caregivers will use the Flight Plan prototype under both controlled lab and in situ conditions. Analysis of objective and subjective usability test data will verify the usability and preliminary usefulness of Flight Plan and guide further refinement. Research Aim 3 is the Pilot Test of Flight Plan's effectiveness and user acceptance. The Pilot Test will be a pre-post randomized controlled trial with baseline and 3 months post-intervention measures of health status, CHF knowledge, and CHF self-care behavior. Flight Plan is hypothesized to improve these measures relative to usual care. Flight Plan is expected to have higher HIT acceptance than other patient-facing HIT systems. Future work will include a larger randomized controlled trial to evaluate Flight Plan's effects on older CHF patients' health outcomes as well as extension of Flight Plan to other geriatric chronic disease domains.